Fosfomycin, cefixime prevent infections in prostate biopsy

In patients undergoing transrectal ultrasound-guided prostate biopsy, prophylaxis with either fosfomycin or cefixime leads to fewer infectious complications, as shown in a study presented at the 38th Annual EAU Congress (EAU 2023).

“Both antibiotics demonstrated to be an alternative to quinolones with low number of infections,” said the researchers, led by Dr Vierira E Brito from the Portuguese Institute of Oncology Coimbra, Department of Urology, in Coimbra, Portugal.

Brito and colleagues conducted this longitudinal study in a tertiary hospital from September 2021 to July 2022 and enrolled patients who were to undergo prostate biopsy. They randomized eligible patients to receive fosfomycin 3 g on the morning of biopsy and 24 hours after or cefixime 400 mg for 3 days, the day prior to biopsy, morning of biopsy, and 24 hours after.

Participants completed a questionnaire before the procedure, 1 week after biopsy, and at 1 month. Those with a history of antibiotic use 3 months prior to biopsy, history of prior infection, current catheterization, biopsy in the past 6 months, immune suppression, or nondelivery of questionnaires were excluded from the analysis.

The questionnaire inquired about the patients’ clinical signs of infection (ie, fever temperature >38 ºC, diagnosis of infection by a doctor, or antibiotic prescription. Finally, the researchers referred to the clinical files of the patients to determine the risk factors.

Of the patients, 118 (mean age 68.7 years) met the eligibility criteria: 50 in the fosfomycin group and 68 in the cefixime group. Their mean prostate-specific antigen (PSA) was 16.7 ng/ml, while the median PSA was 8 ng/ml. [EAU 2023, abstract A0132]

No statistically significant difference was seen between fosfomycin and cefixime in terms of age (68.9 vs 68.5 years), PSA value (26.8 vs 9.3 ng/ml), and other morbidities (p=0.8 and p=0.01, respectively).

Analysis of infections revealed two (4.0 percent) and four (8.0 percent) cases of urinary tract infection (UTI) at 1 week and 1 month, respectively, in the fosfomycin group (p=0.91) and, in the cefixime group, three (4.4 percent) cases at 1 week and only one at 1 (1.5 percent) month (p=0.08). Likewise, no statistically significant between-group difference was observed.

In terms of the total number of infections, the fosfomycin group had six (12.0 percent) cases, while the cefixime group had four (5.9 percent; p=0.023).

In addition, during follow-up, one patient was admitted to the emergency department for haematuria but was discharged on the same day. None of the patients with a UTI diagnosis warranted inpatient care.

On the other hand, another study presented at the EAU 2023 did not recommend the use of fosfomycin prior to prostate biopsy.

“The results [of our study] may have been affected by the unexpected high number of [infections with] Pseudomonas, a bacteria where fosfomycin often lack effect,” the authors said. “If fosfomycin is to be used, it should be with caution if Pseudomonas has been seen in earlier cultures.” [EAU 2023, abstract A0131]